Provider Demographics
NPI:1285675793
Name:RIVKIN, GALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GALINA
Middle Name:
Last Name:RIVKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12131 DORSETT RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2418
Mailing Address - Country:US
Mailing Address - Phone:314-770-1777
Mailing Address - Fax:314-770-1776
Practice Address - Street 1:12131 DORSETT RD
Practice Address - Street 2:SUITE 123
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2418
Practice Address - Country:US
Practice Address - Phone:314-770-1777
Practice Address - Fax:314-770-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004028648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI23865Medicare UPIN